Immer mehr Patienten mit therapierefraktären B-Zell-Neoplasien in Deutschland werden
mit CAR-T-Zellen behandelt. Die Zelltherapie ermöglicht bisher ungekannte Therapieerfolge,
ist jedoch auch mit einer Reihe spezifischer Nebenwirkungen assoziiert. Zusätzlich
stellt sie als personalisierte Tumortherapie besondere Anforderungen an die Patientenlogistik.
Im folgenden Beitrag wird erläutert, worauf in der Versorgung von CAR-T-Zell-Patienten
besonders zu achten ist.
Abstract
CD19 CAR T cells induce – in part long-lasting – remissions in heavily pretreated
patients with relapsed/refractory B-cell malignancies. However, they are associated
with unique toxicities, and patient management therefore requires specific expertise.
In this review, we outline the basics of their mode of action and present the currently
available data on their efficacy in various B-cell and plasma cell malignancies. Currently
approved therapies (Tisagenlecleucel, Axicabtagene ciloleucel, Brexucabtagene autoleucel)
for patients are outlined as well as indications where approvals are expected in the
near future. We discuss practical aspects of CAR T cell therapy from the patient’s
initial presentation, over leukapheresis, to CAR T cell transfusion. Additionally,
we highlight the pathophysiology and principles of the management of the most common
toxicities (cytokine release syndrome [CRS], immune cell associated neurotoxicity
syndrome [ICANS] and cytopenias).
Schlüsselwörter
CAR-T-Zellen - Immuntherapie - Onkologie - Nebenwirkungen
Key words
CAR-T cells - immunotherapy - oncology - side effects
